Multidomain intervention may be associated with improved cognitive function in at-risk elderly patients

A program of diet, exercise, cognitive training, and vascular risk monitoring was associated with improvements in cognitive function, a recent study of at-risk elderly patients found.

The Finnish trial included 1,260 patients between 60 and 77 years of age who had a CAIDE Dementia Risk Score of at least 6 points and cognition either at or slightly below the mean for their ages. They were randomized to either a control group that received general health advice or a 2-year multidomain intervention. Results were published by The Lancet on March 12.

The intervention included group and individual sessions with nutritionists (which encouraged a well-balanced diet focused on fruits, vegetables, whole grains, low-fat meat and dairy, and fish, as well as weight loss if appropriate), strength and aerobic exercise programs tailored by a physical therapist, group and individual cognitive training led by psychologists (including education on cognitive changes and memory and reasoning strategies), and guideline-directed management of metabolic and vascular risk factors by a nurse and physician.

After 2 years, the intervention group had greater mean improvement in cognition, according to the comprehensive neuropsychological test battery Z score (mean change in Z score, 0.20 vs. 0.16 in the control group, working out to a between-group difference in annual score change of 0.022 [P=0.030]). Adverse events occurred in 7% of intervention patients compared to 1% of controls, with the most common being musculoskeletal pain.

Based on the results, the study authors concluded that this multidomain intervention could improve or maintain cognitive function in at-risk elderly patients. They will conduct a 7-year extended follow-up to look for effects of the intervention on the development of dementia and Alzheimer's disease. If such an intervention could delay these problems even modestly, “it would have a huge effect on both individual and societal levels,” the authors wrote. They noted that more research is needed to determine the contribution of each component of the intervention to the observed beneficial effects.